New Job Financial Counseling Representative - Clinic In Hawaii

Under indirect supervision, advises patients and/or family members of health plan benefits and exclusions and financial obligations; collects and verifies membership and other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; processes applications for medical financial assistance (MFA) and/or other applications as appropriate; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions.

Essential Functions:

• Advises patients and/or family members of health plan benefits and exclusions and financial obligations; determines primary coverage when multiple insurances are involved; collects and verifies membership and

other insurance eligibility applicable to services rendered; collects payments, deposits and/or arranges for payment plans as appropriate to services; obtains signed acknowledgement of financial responsibility; interviews patients as referred; obtains and completes information for MSP, Coordination of Benefits (COB) and other regulatory forms as required; collaborates with Patient Accounting collections staff to monitor patient's account according to established criteria.

• Documents pertinent information and financial counseling activities in accordance with department and/or regulatory policies and/or procedures; communicates financial payment issues to appropriate representative in patient care area for non-urgent or emergent care to determine postponement and/or cancellation of services; informs supervisor of potential postponements/ cancellations of elective or nonurgent care.
• Proactively contacts patients to pre-register them for selected procedures and/or those patients with selected insurance coverages; advises patients of estimated cost share; arranges for deposits/pre-payment prior to procedure in accordance with department protocols and procedures.
• Obtains medical record number and benefit information for all new health plan members, visiting members (mainland health plan), and non-plan patients; completes other coordination of benefit protocols as appropriate; obtains signatures on selected insurance claim and authorization to release information/bill (IRA or other) forms; updates system to appropriate identify patients COB or other insurance status as appropriate.
• Processes applications for medical financial assistance (MFA) and/or other applications as appropriate; determines patient's eligibility by interviewing and collecting personal financial information; identifies appropriate hospital, public and/or private financial assistance programs; collaborates and/or refers to Medical Social Services, QUEST, Utilization Management and/or external agencies as needed; obtains necessary authorizations required for services; reinforces established payment guidelines as needed; documents interview, payment arrangements, and all other pertinent information in KP HealthConnect; follows up patients as appropriate.
• Calculates and determines if member has met co-pay maximum; issues co-pay maximum card as needed; requests refunds when appropriate.
• Advises clinic and/or hospital staff regarding processing of non-KPHC charges; provides information regarding professional fees, charges for supplies, and other tools to support operations; directs staff to appropriate tools and/or department for problem resolution; answers patient inquires as needed.
• Assists customers with complaints or inquiries regarding bills and/or charges including, but not limited to, explanation of charges, Kaiser Permanente payment policy, and health plan benefits and exclusions; follows-up on issues as needed; refers complex problems/issues to lead and/or supervisor.
• Reviews and extends charges for non-automated ancillary/other department charges/documents as directed and Ambulatory Surgery Center (ASC) prior to billing; researches canceled surgeries and discrepancies; maintains file of surgery dates, patient forms and type of lens used, as applicable.
• Maintains knowledge of insurance/managed care requirements, and outpatient and/ or inpatient policies and procedures.
• Collects cash, check or credit card payments for collectible services; verifies checks have accurate and current information; ensures valid authorization for all credit card payments; validates checks and credit slips; issues receipts; refunds customers for overpayment of services within authorized limits; obtains all appropriate documents and signatures.
• Balances monies, checks, credit card charge documents and daily cash register receipts; reconciles any discrepancies; prepares bank deposit; operates electronic draft capture for charge cards; reconciles and resolves any discrepancies; remits deposit to bank; places change fund order from bank; maintains change fund; buys and sells change from various departments; resovles any balance discrepancies.
• Orders departmental supplies as needed.
• Demonstrates knowledge, skills, and abilities necessary to provide culturally sensitive care and/or service.
• Performs other duties and accepts responsibility as assigned.

Basic Qualifications:
Experience

• Two (2) years of medical insurance/billings (claim preparation) in health care or related experience.

Education

• High school diploma; or equivalent combination of education (lesser) & experience may be considered in lieu of requirements.

License, Certification, Registration

• N/A

Additional Requirements:

• Type 40 wpm or 35 wpm and demonstrated Windows Navigation skills.
• Demonstrated knowledge of and skill in customer service, oral communication, written communication, problem solving, organizational, interpersonal relations, flexibility, initiative, detail oriented, quality management, independent judgment, confidentiality, results orientation, adaptability, team work, and diversity.
• Demonstrated knowledge of and skill in word processing and spreadsheet PC applications.
• Talking to co-workers, customers, outside vendors, and on the telephone.
• Reading, writing, speaking and understanding English.
• Training/giving and receiving instructions.
• Mathematical ability, attention to detail (e.g. organization, prioritization, proofing), concentration and alertness.

Preferred Qualifications:

• Medicare and Medicaid claims processing experience.
• Financial counseling experience.
• Payment arrangement experience.
• Knowledge of KP computer applications.
• 10-key by touch.
• Knowledge of medical terminology.
• Familiarity with CPT-4 / ICD9.
• Ability to work with medical charts and fee schedules.